Rationale 1: The blood pressure and respiratory rate are considered within normal limits. The heart rate is slightly elevated. Based upon these vital signs, this patient is not critically ill.

Rationale 2: Acute bronchospasm can present a life-threatening situation, which can jeopardize a patients survival. The patients pulse and respiratory rate are elevated, which could indicate a critical illness.

Rationale 3: According to the vital signs, this patient is not critically ill despite being in a motor vehicle crash.

Rationale 4: The patient on receiving hemodialysis for chronic renal failure is not considered critically ill unless another disease process or health issue develops. The patients vital signs are consistent with someone with chronic renal failure.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-1: Define critical care.

Question 2

Type: MCMA

Of the following patients, which will the nurse expect to be transferred to a critical care unit? The patient:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. With an acetaminophen overdose

2. Suffering from acute mental illness

3. With chronic renal failure

4. With acute decompensated heart failure

5. With bacteremia from an infected foot wound

Correct Answer: 1,4,5

Rationale 1: Critical care units are cost-efficient units for caring for patients with specific organ system failure. Patients with acetaminophen overdose often suffer liver failure as a consequence.

Rationale 2: A patient with acute mental illness would not receive care in a critical care unit. This health problem would be considered noncritical.

Rationale 3: Even though critical care units are cost-efficient units for caring for patients with specific organ system failure, chronic renal failure is not a disease process necessitating the critical care environment.

Rationale 4: The patient with acute decompensated heart failure would receive care in a critical care unit. This patient has a specific organ that has failed.

Rationale 5: Bacteremia can affect many organs and lead to multisystem organ failure. This patient would receive care in a critical care unit.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-1: Define critical care.

Question 3

Type: MCSA

The nurse, employed in a hospital in a small rural town, would expect to provide which level of care in the critical care unit?

1. Level I

2. Level II

3. Level III

4. It is unlikely that the hospital would have a critical care unit.

Correct Answer: 3

Rationale 1: This level of care is provided most likely within teaching hospitals and not in a rural facility.

Rationale 2: This level is able to provide comprehensive critical care for most disorders but the unit may not be able to care for specific types of patients. It is unlikely that this level of care would be available in a small rural facility.

Rationale 3: Level III facilities provide initial stabilization of critically ill patients but limited ability to provide comprehensive critical care. A limited number of patients who require routine care may remain in the facility but written policies should be in place determining which patients require transfer and where they ought to be transferred. This level of care is most likely provided in a small rural facility.

Rationale 4: Most hospitals have some level of critical care area.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-2: State the three levels of care provided in critical care units.

Question 4

Type: MCSA

The nurse, providing patient care in an open ICU, would most likely be working with a:

1. Multidisciplinary team with physicians who are also responsible for patients on other units

2. Multidisciplinary team that includes a physician employed by the hospital

3. Physician in charge of patient care who is a specialist in critical care

4. Primary care physician who must consult a critical care specialist

Correct Answer: 1

Rationale 1: In an open ICU, nurses, pharmacists, and respiratory therapists are ICU based but the physicians directing patient care may have other obligations. These physicians may or may not choose to consult an intensivist to assist with the management of their ICU patients.

The nurse, providing care to patients in a critical care unit, realizes that technology increases the likelihood of errors when:

1. It relies heavily on human decision making.

2. Devices are programmed to function without double checks.

3. It makes the workload seem overwhelming to health care providers.

4. There is uniform equipment throughout each facility.

Correct Answer: 2

Rationale 1: This is not identified as increasing the likelihood of errors in the critical care unit.

Rationale 2: Technology changes the tasks people do by shifting the workload and eliminating human decision making.

Rationale 3: This is not identified as increasing the likelihood of errors in the critical care unit.

Rationale 4: This is not identified as increasing the likelihood of errors in the critical care unit.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 6

Type: MCSA

What will the nurse identify as an example of an installed forcing functions or a system level firewall to prevent errors when providing patient care?

1. Prior to administration of insulin, two nurses check the dose.

2. Prior to obtaining a medication, height, weight, and allergies are recorded.

3. All medications are checked by two nurses prior to administration.

4. Undiluted potassium chloride is not available on critical care units.

Correct Answer: 4

Rationale 1: This is not an example of an installed forcing function or a system level firewall.

Rationale 2: This is not an example of an installed forcing function or a system level firewall.

Rationale 3: This is not an example of an installed forcing function or a system level firewall.

Rationale 4: This is an example of an installed forcing function or a system level firewall.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 7

Type: MCSA

The nurse realizes that the increased use of technology in critical care units has resulted in which consequence for patient care?

1. Decreased risk of errors in patient care

2. Decreased therapeutic nurse-patient communication

3. Improved overall patient satisfaction with care

4. Improved patient safety across the entire spectrum

Correct Answer: 2

Rationale 1: This has not been demonstrated as an outcome resulting from an increased use of technology in critical care units.

Rationale 2: This has been demonstrated as an outcome resulting from an increased use of technology in critical care units.

Rationale 3: This has not been demonstrated as an outcome resulting from an increased use of technology in critical care units.

Rationale 4: This has not been demonstrated as an outcome resulting from an increased use of technology in critical care units.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 8

Type: MCSA

The nurse in the critical care area is completing a preoperative checklist before sending a patient for surgery. This nurses activity is an example of which recommendation issued by the Institute of Medicine?

1. Utilizing constraints

2. Simplifying key processes

3. Avoiding reliance on vigilance

4. Standardizing key processes

Correct Answer: 3

Rationale 1: Completing a preoperative checklist is not an example of utilizing constraints.

Rationale 2: Completing a preoperative checklist is not an example of simplifying key processes.

Rationale 3: Completing a preoperative checklist is an example of avoiding reliance on vigilance.

Rationale 4: Completing a preoperative checklist is not an example of standardizing key processes.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 9

Type: MCMA

Which actions should the nurse complete after realizing that an incorrect dose of medication has been administered to a patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Notify the patient and family

2. Notify the physician

3. Document the error

4. Prepare for an analysis of the error

5. Keep the notification of the error silent

Correct Answer: 1,2,3,4

Rationale 1: In a critical care unit that has embraced a culture of safety, practitioners have a responsibility to their patients to make their errors known, have them corrected, and share them with the patient and family.

Rationale 2: In a critical care unit that has embraced a culture of safety, practitioners have a responsibility to their patients to make their errors known, have them corrected, and share them with other practitioners.

Rationale 3: In a critical care unit that has embraced a culture of safety and practice, improvement is a goal rather than punishment. The reporting of errors results in the examination of the factors that contributed to the error and changes practice patterns.

Rationale 4: In a critical care unit that has embraced a culture of safety and practice, improvement is a goal rather than punishment. The reporting of errors results in the examination of the factors that contributed to the error and changes practice patterns.

Rationale 5: Withholding information about a medication error is not creating a culture of safety.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 10

Type: MCSA

The nurse working within the AACN Synergy Model realizes that optimal patient outcomes are realized when:

The nurse is aware that decision-making capacity is likely to be impaired for a patient who:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Is being medicated for severe pain

2. Does not understand the medical condition

3. Has been diagnosed with septic shock

4. Is depressed

5. Asks questions about identified treatments

Correct Answer: 1,2,3,4

Rationale 1: The patient must be capable of rational thought and be able to recognize what the prospective treatment involves.

Rationale 2: Understanding the health condition is one component of informed consent.

Rationale 3: It is common for health care providers and family members to question the decision-making ability of critically ill patients. Many critically ill patients lack the capacity to give informed consent.

Rationale 4: Patients who are depressed may not be capable of thinking clearly.

Rationale 5: Asking questions about identified treatments is not a characteristic of a patient with impaired decision-making ability.

When a nurse employs conscientious refusal to participate, the nurse should be aware that:

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It may lead to dismissal from a nursing position.

2. Consequences may involve employer sanction.

3. Nursing administrators are largely supportive.

4. State boards of nursing protect the nurse in this situation.

5. The patient will support the nurses decision.

Correct Answer: 1,2

Rationale 1: The repercussions for the nurse of employing conscientious refusal may include dismissal from the current nursing position.

Rationale 2: The nurse must also consider the amount of support that will be received from the administration of the institution.

Rationale 3: Institutions vary from being supportive of conscientious refusal and changing their institutional policies to support it, to being legally required by some states to allow nurses to utilize it, to being able to dismiss the nurse who utilizes it.

Rationale 4: Institutions vary from being supportive of conscientious refusal and changing their institutional policies to support it, to being legally required by some states to allow nurses to utilize it, to being able to dismiss the nurse who utilizes it.

Rationale 5: If the patient and family have developed a relationship with the nurse, they may wish the nurse to remain with them beyond the decision-making phase to see the planned action accomplished and to help them cope with the consequences of their decision.

The nurse is providing care to patients in a Level II general critical care unit. For which types of patient problems will this nurse most likely provide care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Exacerbation of heart failure

2. Wound infection

3. Burns over 50% of total body surface

4. Kidney transplant

5. Reattachment of a traumatic amputation of the left leg

Correct Answer: 1,2

Rationale 1: A Level II critical care area is where comprehensive care for most disorders will be provided. Exacerbation of heart failure would not be considered specialized care.

Rationale 2: A Level II critical care area is where comprehensive care for most disorders will be provided. A wound infection would not be considered specialized care.

Rationale 3: A Level II critical care area is where comprehensive care for most disorders will be provided. The unit may not be able to care for specific types of patients and transfer arrangements to Level I facilities must be in place for patients with the specific disorders for which the unit does not provide care such as a burn unit.

Rationale 4: A Level II critical care area is where comprehensive care for most disorders will be provided. The unit may not be able to care for specific types of patients and transfer arrangements to Level I facilities must be in place for patients with the specific disorders for which the unit does not provide care such as a transplant unit.

Rationale 5: A Level II critical care area is where comprehensive care for most disorders will be provided. The unit may not be able to care for specific types of patients and transfer arrangements to Level I facilities must be in place for patients with the specific disorders for which the unit does not provide care such as a trauma unit.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-2: State the three levels of care provided in critical care units.

Question 26

Type: MCMA

A patient is admitted to an open intensive care unit. In addition to the nurse, which health care providers will assist in the care of this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Pharmacist

2. Respiratory therapist

3. Attending physician

4. Dietician

5. Social worker

Correct Answer: 1,2,3

Rationale 1: In an open ICU, pharmacists are ICU based.

Rationale 2: In an open ICU, respiratory therapists are ICU based.

Rationale 3: In an open ICU, the physicians directing patient care may have other obligations. These physicians may or may not choose to consult an intensivist to assist with the management of their ICU patients.

Rationale 4: Dieticians are not identified as patient care staff in an open intensive care unit.

Rationale 5: The social worker is not identified as patient care staff in an open intensive care unit.

The critical care nurse is identifying patients at risk for safety and medical errors. Which patients would the nurse identify as being at risk for these issues?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Patient in isolation with MRSA

2. Patient who does not understand English

3. Patient with end stage renal disease and a respiratory rate of 8 per minute

4. Patient recovering from pacemaker insertion

5. Patient with pulmonary edema

Correct Answer: 1,2,3

Rationale 1: The most vulnerable of unstable ICU patients who are at highest risk for medical error include patients in isolation.

Rationale 2: The most vulnerable of unstable ICU patients who are at highest risk for medical error include patients with limited English proficiency.

Rationale 3: The most vulnerable of unstable ICU patients who are at highest risk for medical error include patients at end of life.

Rationale 4: Recovering from pacemaker insertion is not identified as being a member of a vulnerable population.

Rationale 5: Being treated for pulmonary edema is not identified as being a member of a vulnerable population.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-4: Explain why critical care units are one of the most common sites for health care errors.

Question 28

Type: MCMA

The nurse manager of a critical care unit is explaining the AACN Synergy Model to the critical care nurses. What will the manager include as basic parts of this model?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Based on the patients characteristics

2. Based on the competencies of the nurses

3. Patient outcomes will be measured

4. The nurses assessment of patient outcomes will be measured

5. Reduction of cost to provide critical care services to patients

Correct Answer: 1,2,3,4

Rationale 1: This model is based on the patients characteristics.

Rationale 2: This model is based on the nurses competencies.

Rationale 3: This model is based on outcomes derived from the patient.

Rationale 4: This model is based on outcomes derived from the nurse.

Rationale 5: Cost reduction strategies are not a part of the AACN Synergy Model.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1-5: Describe the relationship between the patient and the nurse in the AACNs Synergy Model.

Question 29

Type: MCMA

While completing a self-evaluation, the critical care nurse compares personal practice to the competencies identified by the AACN Synergy Model. Which behaviors are consistent with those in the Synergy Model?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Seeks out research studies to update protocols

2. Approaches patient care by looking at the big picture

3. Ensures family members are comfortable when visiting critical care patients

4. Encourages patient families to discuss issues with the physician

5. Telling the next shift that a patient needs help with understanding instructions

Correct Answer: 1,2,3,4

Rationale 1: This behavior demonstrates the competency of clinical inquiry.

Rationale 2: This behavior demonstrates the competency of clinical judgment.

Rationale 3: This behavior demonstrates the competency of caring.

Rationale 4: This behavior demonstrates the competency of advocacy.

Rationale 5: This behavior does not demonstrate an AANC competency for nurses in a critical care area.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1-6: Discuss the competencies of critical care nurses as defined by the Synergy Model.

Question 30

Type: MCMA

What would be appropriate reasons for an Intensive Care Unit intensivist to call a huddle?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Make care providers aware of a change in a patients situation.

2. Communicate a critical issue about a patient.

3. Make an assignment change.

4. Discuss concerns about a patients status or care.

5. Plan care for the shift.

Correct Answer: 1,2,3,4

Rationale 1: Huddles are used so that team members may regain situation awareness.

Rationale 2: Huddles are used so that team members may discuss critical issues.

Rationale 3: Huddles are used so that team members may assign resources.

Rationale 4: Huddles are used so that team members may express concerns.

Rationale 5: Huddles are not used to plan care for the shift.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1-7: Describe ways to enhance communication and collaboration among members of the health care team.

Question 31

Type: MCMA

The nurse manager, concerned that several staff nurses are experiencing moral distress, is planning to implement the 4 As to Rise Above Moral Distress. What are the steps in this tool?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Ask

2. Affirm

3. Assess

4. Act

5. Assert

Correct Answer: 1,2,3,4

Rationale 1: Ask is a step in the 4 As to Rise Above Moral Distress tool.

Rationale 2: Affirm is a step in the 4 As to Rise Above Moral Distress tool.

Rationale 3: Assess is a step in the 4 As to Rise Above Moral Distress tool.

Rationale 4: Act is a step in the 4 As to Rise Above Moral Distress tool.

Rationale 5: Assert is not a step in the 4 As to Rise Above Moral Distress tool.